One of the objectives of the nasal tip surgery is to create harmony of Contour, Position and Projection of the nasal tip with the other " volumes " of the nasal pyramid ; most often the surgeon's goal is to obtain :a nasal tip which stands out from the dorsal line by 2 or 3 mm and a sligthly convex columella-lobular profile.

Difficult cases are seen in patients who presents with a short columella , weak and non resilient alar cartilages , thick skin and a substantial cartilaginous hump . In such a case , after lowering the anterior septal border in an incrementally , a supra-tip deformity may develop, because the poorly projecting tip lacks the strenght to project over a lowered dorsum.

Fig. 1 : A shield graft (Sheen) placed in the infratip segment may provide augmentation of the tip projection and an improvment of teh tip contour

Fig. 2 : Nasal tip has been refined by minimal resections of the alar cartilages and by a Tip cartilage graft